As Washington moved to reduce federal funding for women’s health this year, adversaries in the war over affordable birth control and other women’s health services shifted the battleground to state capitals — resulting in a spate of new laws that both expand and contract women’s access to care.

It happened quickly in Iowa. In May, then-Gov. Terry Branstad, a Republican, signed a bill defunding Planned Parenthood. Medicaid dollars stopped flowing to the group July 1, and four of the state’s Planned Parenthood clinics closed within a week.

That left nearly 15,000 women in small communities without access to reproductive health services, including cancer screenings, birth control, testing for and treatment of sexually transmitted diseases, and annual checkups.

Medicaid pays for three-quarters of all publicly supported women’s health programs. So when Iowa abruptly cut off Medicaid dollars to Planned Parenthood, it was game over, said Jodi Tomlonovik, executive director of the Family Planning Council of Iowa, which oversees distribution of federal and state money to women’s health clinics.

Iowa’s law, which applies to Planned Parenthood and any other women’s health clinics affiliated with a group that performs abortions, may also defund women’s clinics in the state’s largest health care system, UnityPoint Health, as well as the University of Iowa Hospitals and Clinics, because certain clinics in both groups perform abortions in cases of fetal abnormalities, she said.

In three other states with GOP governors and legislatures — Arizona, Kentucky and South Carolina — 2017 state budgets that exclude Planned Parenthood and other women’s health clinics affiliated with an abortion provider from all state and federal funding may have similar effects on local clinics.

And in a first-of-its-kind approach to defunding abortion providers, Texas asked the federal government in May for permission to recreate a Medicaid family planning program it eliminated four years ago so it could create a state-funded plan. This time, Texas wants to exclude Planned Parenthood and other abortion providers from participating in the program, and fund it with federal Medicaid dollars.

If the request is approved, many more states can be expected to file similar applications, said Elizabeth Nash, a policy analyst at the Guttmacher Institute, which tracks reproductive health policy.

In sharp contrast, Nevada and Maine, both led by Republican governors, enacted new laws mandating insurance companies cover the costs of all U.S. Food and Drug Administration approved forms of contraception without delay and without requiring women to try the cheapest method first, as some insurers now do.

Oregon, a state with a Democratic governor and Legislature, did the same thing, adding abortions to the list of reproductive services insurers must cover. And Maryland became the first state to enact a law committing state funds to Planned Parenthood if federal funds are taken away.

Lawmakers in California, Connecticut, New Jersey, New York and Wisconsin considered similar measures this year. Nevada appropriated $1 million over two years for family planning services to replace any cuts in federal money for Planned Parenthood.

States also enacted two other types of laws designed to ease access to birth control pills and other forms of contraceptives. Colorado, Maine, Nevada, New York, Virginia and Washington enacted laws requiring all insurers to cover 12-month prescriptions of birth control pills to make it easier for women to take the pills without interruption, particularly those who must travel long distances to a drugstore.

Maryland, New Mexico and Oregon enacted or updated laws allowing pharmacists to prescribe birth control pills, patches and other forms of contraception that do not require a doctor to administer.

The flurry of state legislative activity on women’s health issues this year is a direct result of the federal policy shifts on women’s health since President Donald Trump took office, said Danielle Wells, a spokeswoman on state policy issues for Planned Parenthood.

But she cautioned that state initiatives can only go so far to mitigate what she said would be very damaging effects on women’s health care if the federal government decides to defund Planned Parenthood.

“While it’s heartening to see state lawmakers put women’s health ahead of politics, at the end of the day, if Congress votes to prohibit individuals on Medicaid from accessing care at Planned Parenthood, no amount of state support will be able to fill that gap,” Wells said.

Without Planned Parenthood clinics, use of contraception would decline and abortion rates would likely rise, Nash said. Wider use of contraception accounted for a 14 percent drop in the U.S. abortion rate between 2011 and 2014, according to Guttmacher, and for a reduction in the rate of unplanned pregnancies as well.

But abortion opponents argue that the nation’s declining abortion rates are due to tougher state abortion laws, and they maintain that women will still be able to obtain birth control and other reproductive health services from a variety of other health care providers without funneling taxpayer dollars to Planned Parenthood.

“The issue is not contraception, the issue is why should we give the nation’s No. 1 abortion provider more than a half a billion dollars to provide a service that is better provided by other medical centers where women can receive full-service care,” said Kristi Hamrick, spokeswoman for Americans United for Life, an anti-abortion advocacy group.

Over the last six years, a handful of Republican-led states have tried to chip away at funding for Planned Parenthood, one of the nation’s largest providers of women’s health care. The most common tactic has been to exclude the group from Medicaid’s network of providers.

Indiana was the first state that attempted to block Planned Parenthood funding, followed by Alabama, Arizona, Arkansas, Florida, Kansas, Louisiana, Mississippi, Oklahoma and Texas. In nearly every case, courts shot down their attempts to prohibit the abortion provider from participating in state Medicaid and federal grant programs.

In December, President Barack Obama signed a Health and Human Services rule clarifying that states could not block funding to health care providers for purely political reasons.

But that policy was quickly reversed when Trump took office.

Less than four months into his administration, Trump signed a law allowing states to do just what they had been trying to do for years — exclude Planned Parenthood from Medicaid and other women’s reproductive health care programs, despite a federal Medicaid statute that prohibits it.

At the same time, Republicans in Congress repeatedly have called for elimination of the roughly $300 million federal grant program known as Title X that funds Planned Parenthood and other local family planning clinics.

And in May, a leaked Health and Human Services proposal revealed that the Trump administration intends to undo a provision in the federal health law that requires nearly all employers to include coverage of all forms of contraception in their employee health plans. If the proposal takes effect, it would make it easy for employers to opt out of coverage of contraception for religious or moral reasons.

Those actions and the uncertain future of the Affordable Care Act have stripped Planned Parenthood and many other women’s health clinics of any certainty about their financial future, causing some to put off any plans for expansion.

Despite setbacks in Iowa and other states, Planned Parenthood’s Wells says women’s health advocates have been buoyed by their successes in several GOP states — and by the overall number of women’s health initiatives this year. She attributes the unprecedented level of state activity in support of her group and its goals to a national groundswell of activism that started with the Women’s March on Washington early this year, and the momentum in state capitols that has been sustained since.

But other women’s health advocates worry that just as many states, emboldened by the Trump administration’s apparent green light on defunding women’s health, will move quickly to cripple Planned Parenthood clinics in their states.

“People should be very concerned about what states are doing around Medicaid and women’s health now that the new administration has reversed Obama-era protections,” said Mara Gandal-Powers, senior counsel with the National Women’s Law Center.

A recent poll by the Kaiser Family Foundation found that three-quarters of the American public, and a majority of Republicans, favor continuing federal funding of Planned Parenthood for non-abortion services.

At least 38 million U.S. women of reproductive age need contraceptive services because they are sexually active and do not want to become pregnant, according to Guttmacher. In 2014, more than half of them needed subsidized services because they were unable to purchase contraception on their own. Thirty-nine percent of those received care at federally funded clinics, including Planned Parenthood, or from private practice doctors serving Medicaid enrollees.

For state Medicaid programs, preventing unintended pregnancies makes financial sense. Every dollar spent on publicly funded family services yields $4 in Medicaid savings, because unintended births are avoided, according to the National Partnership for Women and Families. Total public expenditures on unintended pregnancies in the U.S. were an estimated $21 billion in 2010, nearly a third of which was state money.

The potential demise of the Affordable Care Act, with its expansion of Medicaid and required coverage of birth control for all women at no cost, represents by far the biggest potential loss to women’s health.

More than 55 million women gained access to free contraception and preventive services under the ACA starting in 2013, according to the National Women’s Law Center.

“Things got better under the ACA. It reset the baseline,” Gandal-Powers said. “That’s why we’re seeing such vocal and active pushback against what is happening in women’s health now.”

California boasts some of the toughest “fair pay” laws in the country, yet the average full-time working woman has been earning only 86 cents for every dollar earned by a man. A recent study concluded that gap won’t close before the year 2043.

Two female lawmakers don’t intend to wait that long.

The Legislature, which in the past two years has approved a series of bills aimed at gender pay equity for substantially similar work, is considering going even further this session. The first proposal would bar a prospective employer from asking a job applicant about prior salary; the second would require large employers to publicly disclose the median earnings of salaried employees and board members, by gender.

“This is an issue I remember writing high school papers about — and it’s still an issue,” said Democratic Assemblywoman Lorena Gonzalez Fletcher of San Diego, who has introduced one of the bills and co-authored the second. She cited the 2043 forecast by the Institute for Women’s Policy Research.

“For my daughter, who is entering the workforce now, that’s her entire life in the workforce without pay equity,” she said. “We have to take really bold steps to make sure we speed up this timeline.”

These may be bold steps, but in the wrong direction, say most of the major business groups in the state. Over the last two years, groups like the California Chamber of Commerce and the National Federation of Independent Business say they have played nice with progressive lawmakers, supporting — or at least not outright opposing — compromise legislation designed to narrow the wage gap without saddling businesses with excessive costs. But they say the initiatives introduced this year are untested, punitive and being rolled out before recently adopted reforms have had time to make a difference.

Although the most recent U.S. Census data, for 2015, reveals a 14-cent gap between the average wages of full-time male and female employees, California is still ahead of the U.S. as a whole. Nationwide, female employees earn an average 20 cents less than full-time male employees.

But over the last 10 years, the disparity across the state has barely budged.

In 2015, Gov. Jerry Brown signed a bill by Democratic Sen. Hannah-Beth Jackson of Santa Barbara that made it more difficult for an employer to justify paying men and women a different wage for “substantially similar work.” Last year, a law authored by former San Jose Democratic Assemblywoman Nora Campos took effect to prohibit employers from using prior pay as the sole justification for a disparity in earnings.

But this year’s bills are different, said Shawn Lewis, California communications director for the National Federation of Independent Businesses, which represents small-business interests.

“We acknowledge that gender pay inequality is an issue,” he said. But this year’s initiatives “undo some of the pragmatic, collaborative efforts” of recent years and, more importantly, he said, they won’t solve the problem of pay inequality.

The bill to prohibit job interview questions about prior salary, was introduced by Assemblywoman Susan Eggman, a Democrat from Stockton. Supporters argue that using prior earnings to determine current salary allows historic discrepancies in pay between men and women to persist from one job to the next, regardless of an employer’s intent.

“If you’re historically underpaid, using salary history just bakes in the inequity,” Eggman told a Senate panel at a recent hearing on AB 168.

Whether that’s true or not is subject to debate. Despite a recent wave of similar legislation passed in Massachusetts and in cities like San Francisco, New York, and Philadelphia, none of these new laws have been in place long enough to have a discernible effect. Meanwhile, business groups and organizations that represent state employers argue that past salary can be useful information for an employer, who may not know what the prevailing wage is when hiring an employee. They also contend that the Campos bill, which already puts restrictions on an employer’s use of pay history, only went into effect on Jan. 1 of this year and should be given more time to have an effect.

“If an employer asks an employee about his or her prior salary, yet ultimately pays the applicant a higher salary than any of the applicant’s male colleagues, that employer could still be sued,” Jennifer Barrera, a lobbyist for the California Chamber of Commerce said in a letter submitted to lawmakers earlier this month.

That, she said, is “simply unfair.”

“California’s largest businesses are working overtime to make sure that the slightest wage differentials can be justified on nongender or nonrace or nonethnicity grounds,” Mike Belote, representing the California Employment Law Council, a business interest group, told the same Senate hearing. While the business community supports “the mission” of equal pay, he said, the bill intrudes too far into negotiations between employers and employees and exposes firms to legal liability simply for asking a question.

But supporters of the bill say the business community is overstating how much the bill would interfere with standard hiring practice. Employers can still make any offer they choose and applicants are still free to haggle accordingly, using salary history as a bargaining chip if need be.

“It doesn’t keep anyone from saying, ‘Gosh, that’s not what I made at my last job; I’d like to make more,” responded Sen. Connie Leyva, a Democrat from Chino.

The second bill, which also passed through the Assembly and is now being considered by the state Senate, aims at reducing the wage gap through mandatory transparency. Assemblywoman Gonzalez-Fletcher’s AB 1209 mimics a 2016 Obama administration executive order that requires large private companies and all federal contractors to submit pay data, broken down by sex, race, and ethnicity. The Republican-controlled Congress is now considering defunding that order.

“Often employers themselves aren’t aware of that there are these disparities,” said Jessica Stender, senior staff attorney at Equal Rights Advocates, a civil rights legal organization that sponsored AB 1209 and supports both bills.

Under California law, a wage gap between men and women can be justified based on seniority, a merit system or some other “bona fide factor other than sex,” such as past training, education or productivity. By forcing businesses to analyze the gap, said Stender, companies will be required to self-assess and see if their pay trends are justified under the law.

“If there is no gap, then that’s great — we’ve confirmed that there’s no issue,” she said. “But if there is one, then it gives them a chance to dive a bit deeper.”

Not surprisingly, California business groups are not keen on the invitation. Instead Lewis from the National Federation of Independent Business said the true intent of the bill is “shaming companies based on partial data and opening doors to litigation.”

If women are more likely to request time off or more flexible hours, that would result in average lower pay. That kind of difference, if published, could be misinterpreted or, said Lewis, intentionally misrepresented in anti-discrimination litigation.

That’s in part because there isn’t a single, malevolent cause that explains the wage gap. Instead the reasons are many.

A recent study by economists from Massachusetts and Oslo, Norway, analyzed the pay data of 15 million Americans and found that more than a quarter of the wage gap could be explained by women opting into lower paying professions and industries than men. Most of the gap, instead, was explained by different levels of salary growth at a given job — in other words, when men and women go to work for the same company or organization, men tend to receive larger raises more frequently.

This result was particularly pronounced for those with college educations: The average man with a bachelor’s degree earns 55 percent more than the average college-educated woman, the study found. Why? Certainly overt discrimination plays a role. Likewise, women are often less willing to negotiate higher salaries than men. And then there is the responsibility, often unevenly shared, of child care.

According to the authors of the study, though jobs that require higher education tend to offer the best opportunities for future salary growth, “among married couples, the household division of labor tend to limit women’s career choices.” In other words, heterosexual married couples — especially those with children — are more likely to prioritize the career of the man at the expense of the woman’s.

None of these factors mean lawmakers should accept the pay gap as either inevitable or justifiable, Stender said. But it does paint a more complicated picture, one in which differences in earnings aren’t solely the fault of bigoted employers, but of broader social inequalities and attitudes. That, she said, argues for a whole host of policies aimed not just at pay, but also family leave and access to child and health care services.

But first, she contends, it’s necessary to figure out where the pay gaps exist: “You can’t fix what you don’t see.”